Disclosure strategies, social support, and quality of life in infertile women

Latent Profile Analysis of Stigma in Infertile Women and its Influencing Factors

PURPOSE

Infertility, a global health challenge, often leads to stigma for affected women. This stigma brings negative impacts to infertile women, and is influenced by several factors. Research to date treats infertile women as a homogeneous group based on their stigma. We attempted to identify subgroups based on their stigma and explored variables associated with subgroups.

METHODS

A cross-sectional study design was utilized, involving 439 infertile women. General information questionnaire, Infertility Stigma Scale, Perceived Social Support Scale, and the Chinese version of the Infertility Self-Efficacy Scale were used. Latent profile analysis was performed to categorize potential stigma profiles in infertile women. Multinomial logistic regression analysis was employed to explore the influencing factors of stigma among infertile women in different latent profiles.

RESULTS

Four hundred thirty-nine infertile women were divided into three stigma profiles: low stigma level-light public stigma group (41.5%), medium stigma level-light public stigma group (48.0%), and high stigma level-deep public stigma group (10.5%). Multinomial logistic regression showed that education level, per capita family income status, duration of infertility, duration of infertility treatments, perceived social support, and self-efficacy were the influencing factors of stigma in three latent profiles.

CONCLUSION

Stigma in infertile women can be divided into three potential profiles, which had obvious classification characteristics. In these different latent profiles, there are differences in education level, per capita family income, duration of infertility, duration of infertility treatments, perceived social support, and self-efficacy. Social withdrawal is a common and severe issue faced by infertile women. Additionally, infertile women with high stigma levels often suffer from more severe public stigma.

A Secondary Analysis of a Cross-Sectional Study to Examine Factors Associated with Marital Benefit Among U.S. Women with Infertility

Infertility in women causes profound psychological distress and may affect the coupled relationship. Few studies have considered the strengthening of the relationship, or marital benefit, of women with infertility. This study sought to investigate factors associated with marital benefit, such as infertility-related stress, partner communication, sexual satisfaction, coping strategies, and quality of life satisfaction. We used a descriptive cross-sectional study design to recruit 197 U.S. women with infertility who were undergoing fertility treatments from infertility-related Facebook support groups to complete an online survey. We used SPSS 28 to conduct descriptive statistics, Pearson correlations, and multiple linear regression. Partner communication, sexual satisfaction, primary infertility, meaning-based coping, marital stress, quality of life satisfaction, and attending a support group were significantly associated with marital benefit. The multiple linear regression model accounted for 43% of the variance in marital benefit, and six variables had a significant relationship with marital benefit: meaning-based coping (p <.001), marital stress (p = .003), partner communication (p <.003), primary infertility (p = .014), active-avoidance coping (p = .020), and attending a support group (p = .006). Interventions to decrease marital stress and improve coping and partner communication could be beneficial to facilitating marital benefit in women with infertility.

What women want to hear: the helpful and unhelpful comments reported by women struggling with infertility amidst the COVID-19 pandemic

INTRODUCTION

Many women struggling with infertility report that they frequently experience unhelpful social interactions with well-meaning loved ones and healthcare providers, contributing to a reluctance to confide in others about their infertility and emotional distress. However, it remains unclear what interaction content women experience as 'helpful' versus 'unhelpful,' making it difficult to provide concrete recommendations to the public about how best to support individuals struggling with infertility.

METHODOLOGY

Eighty women from Canada and the United States (ages 20-45 years) whose fertility treatments had been cancelled due to the COVID-19 pandemic were recruited via social media to complete an online survey, which included two open-ended questions about the most helpful and unhelpful social interactions they had had about their infertility. Two independent researchers conducted content analysis to identify categories of helpful and unhelpful social interactions.

RESULTS

The following six categories were identified by women as helpful: 1) Listening, 2) Fostering hope, 3) Talking to individuals with lived experience, 4) Distraction, 5) Validating emotions, and 6) Tangible support. Responses about unsupportive interactions fell into four categories: 1) Toxic positivity, 2) Advice-giving, 3) Invalidation, and 4) Intruding. Sample quotes from each category are provided.

CONCLUSION

These findings provide valuable insights that can be used to develop future educational materials for the general public on how to interact with individuals experiencing infertility.

Depressive symptoms and quality of life among women experiencing infertility: The moderating effect of perceived social support

Background

Infertility constitutes a leading reproductive health problem with profound psychosocial outcomes, including elevated depressive symptoms that compromise quality of life (QoL). While the literature has suggested social support as a protective psychological mechanism, its role in depressive symptoms and QoL among women with infertility remains underexplored. This study aimed to examine the moderating effect of perceived social support on the relationship between depressive symptoms and QoL among South Korean women experiencing infertility.

Methods

Utilizing a cross-sectional design, this study analyzed a secondary dataset comprising 186 South Korean women with infertility. Participants were asked to complete the online survey which included the following scales: The Korean adaptation of the Patient Health Questionnaire-9 (PHQ-9), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Fertility Quality of Life (FertiQoL) tool. Moderation analysis was conducted using Hayes' PROCESS Macro 4.1 Model 1. Statistically significant effects were identified if the confidence intervals did not include zero. Depression acted as the predictor, social support as the moderator, and QoL as the dependent variable.

Results

Depressive symptoms exhibited a moderate negative relationship with fertility QoL (r = -.41, p < .001). When stratified by PHQ-9 severity, correlations between depressive symptoms, social support, and fertility QoL were only significant for the group with mild or no depressive symptoms. In this group, depressive symptoms negatively predicted fertility QoL (ß = -.92, p < .05), and a significant interaction effect between depressive symptom severity and social support on fertility QoL was observed (ß = -1.24, p < .05).

Conclusion

Perceived social support has a moderating effect on the relationship between depressive symptoms and fertility QoL only for women with mild or no depressive symptoms. Consequently, nursing interventions for South Korean women with infertility should focus on emotional and social support, which include enhancing individual coping skills and facilitating community-based support networks. These can be implemented through specialized educational initiatives and expert-moderated online forums, aiming to enhance the emotional well-being of women experiencing infertility.

Disclosing Sexual Dysfunction in Newly Established Romantic Relationships: An Experimental Test of Five Strategies from the Revelation Risk Model

Guided by the revelation risk model, we conducted an online experiment (N = 400) to assess five strategies (i.e. initiate, response, third-person disclosure, humor, evidence) used to hypothetically disclose two types of sexual dysfunction (SD) - vulvovaginal pain (VVP) and erectile dysfunction (ED) - in romantic relationships of six months or less. Results indicated that relationship investment varied depending on the SD disclosed, such that participants who imagined that their partner disclosed ED were less invested than those who imagined that their partner disclosed VVP. Results also indicated that intention to continue the relationship varied depending on the SD disclosed and strategy used, such that participants who imagined that their partner disclosed VVP were most likely to intend to continue their relationship when their partner responded to a reference to their SD, whereas participants who imagined that their partner disclosed ED were most likely to intend to continue their relationship when their partner left behind evidence of their SD. Theoretical and practical insights that advance our understanding of disclosing SD in newly established romantic relationships and disclosure theorizing are offered.

Examining the association between coping strategies and perceived social support among Vietnamese infertile women undergoing IVF treatment

The purpose of the study was to examine the association between coping strategies and perceived social support among women diagnosed with infertility and undergoing IVF treatment. A total of 383 Vietnamese women were invited to participate in this study. Participants completed a questionnaire consisting of The Multidimensional Scale of Perceived Social Support, the Copenhagen Multi-centre Psychosocial Infertility coping scales and the Fertility Problem Inventory, and other relevant questions. The results reveal that coping strategies significantly predict some specific types of perceived social supports among women undergoing IVF treatment. Specifically, passive-avoidance coping (PAC) and active-avoidance coping (AAC) predicts a decrease in receiving support from family and friends, whereas active-confronting coping (ACC) predicts an increase in receiving support from these two sources of support. Women who demonstrate increased meaning-based coping (MBC) received all three sources of support including family, friends, and significant others support. Despite some limitations, this study is useful in understanding how coping strategies among women undergoing IVF treatment affects the social support received in the Vietnamese social context. It also emphasizes the importance of psychological support for women facing IVF treatment distress.

The effectiveness of expressive art therapy on infertile women undergoing surgery: study protocol for a randomized controlled trial

BACKGROUND

Infertility produces infertility-related stress in both members of infertile couples, especially for infertile women. Some studies verified the negative relationship between infertility-related stress and outcomes of infertility treatments. Effective mental health care during fertility treatment is urgently needed, but there has been a lack of efficient support services. To reduce the infertility-related stress of infertile women, expressive art therapeutic schemes will be organized and implemented by certified international expressive art therapists.

METHODS

This study is a randomized controlled trial. Participants in the intervention group will receive expressive art therapies after the baseline investigation. Expressive art therapies will be led by the certified international expressive art therapist. The interventions include progressive muscle relaxation training, music meditation and drawing therapy. Participants in the control group will receive routine care. The Hospital Anxiety and Depression Scale (HADS) and Fertility Problem Inventory (FPI) will be used to investigate the anxiety, depression, and infertility-related stress of all participants at admission and at discharge.

DISCUSSION

This study will verify the effectiveness and efficiency of expressive art therapies for infertile women. The results will provide new knowledge on mental health care strategies for infertile women.

TRIAL REGISTRATION

ChiCTR, ChiCTR2300070618. Registered 14 April 2023.

Testing a Model of Disclosure, Perceived Support Quality, and Well-Being in the College Student Mental Illness Context: A Weekly Diary Study

Prominent disclosure models elucidate decisions to disclose health information, yet explanations for disclosure consequences remain underdeveloped. Drawing on Chaudoir and Fisher's disclosure process model, this study aims to advance understandings of how disclosure to a parent contributes to well-being for college students with mental illness. We tested a mediational model in which, at the within-person level, perceived support quality explains the association between on-going disclosure of mental illness-related experiences and well-being. Participants were 163 college students who self-identified as having mental illness and who completed six consecutive, weekly surveys. A multilevel analysis showed that increases in disclosures of mental illness-related experiences, relative to participants' mean level, were associated with enhanced well-being via perceptions of higher quality support, above and beyond between-person differences. This study contributes to the literature by offering an explanation for the effects of disclosure on well-being and underscores the importance of capturing disclosures over time.

A review of the psychometric properties and implications for the use of the fertility quality of life tool

OBJECTIVES

To analyze and synthesize the reported psychometric properties of the Fertility Quality of Life (FertiQoL) instrument and describe its implications for use in practice and research in men and women with infertility.

METHODS

A systematic literature search was performed to identify all articles using the FertiQoL tool. PubMed, CINAHL, and PsycINFO were searched from September 2006 through May 2022. Studies were eligible for inclusion if they reported psychometric data on the original FertiQoL tool using a sample population of individuals with infertility. Sample size, country of origin, and psychometric data were documented for each study.

RESULTS

The initial search revealed 153 articles that had utilized the FertiQoL. Following abstract, title, and full-text screenings, 53 articles reported psychometric data and met criteria for inclusion. The FertiQoL is a sound measurement with satisfactory reliability and validity. Studies indicated adequate reliability in the overall scale ([Formula: see text]), as well as the core Emotional, Mind/Body, Social, and Relational scales ([Formula: see text]) and two optional Tolerability and Environment fertility treatment subscales ([Formula: see text]). Although the Relational subscale exhibited slightly lower reliability in several studies, the internal consistency for the measurement as a whole was satisfactory. Results also indicate adequate: 1) face and content validity with extensive professional and patient feedback during development; 2) convergent validity with general quality of life, depression, and anxiety measurements; and 3) structural validity using both confirmatory and exploratory factor analyses.

CONCLUSION

The FertiQoL tool is the most commonly used instrument to measure the impact of fertility issues on quality of life in men and women with infertility. Understanding the impact of infertility on quality of life provides valuable insight into the areas of infertility-related care that need to be prioritized, such as mental health or relational stressors. While the instrument has been used in different patient populations with infertility and available in multiple translations, it is necessary to understand the updated psychometric properties and the implications for its use. This review shows that the FertiQoL is reliable and valid for cross-cultural use among individuals with various etiologies of infertility.

Dual mediating effects of social support and fertility stress on mindfulness and fertility quality of life in infertile men: A case-control study

Background

Infertility is one of the three major public health problems in the world, bringing immense physical and psychological damage to men and affecting the quality of men’s fertility life. Thus, the purpose of this study was to analyze the status of social support, fertility stress, mindfulness, and fertility quality of life in infertile men, and to explore the dual mediating effects of social support and fertility stress on mindfulness and fertility quality.

Methods

A case–control group study was conducted, with 246 men in the case group and 149 in the control group. The Social Support Scale, Fertility Stress Scale, Mindfulness Scale, and Fertility Quality of Life Scale were used to establish a structural equation model using Mplus 8.3 to explore social support and fertility stress. Pathway relationships were drawn between mindfulness and fertility quality of life in infertile men.

Results

There were significant differences between infertile and healthy men in each dimension of the core module of fertility quality of life, in the total score of the treatment module, in the total score of social support, in subjective and objective support, and in the total score of fertility stress, social pressure, sexual pressure, marital relationship, and childless pressure (p &lt; 0.05 in each case). Further, the fertility quality of life in infertile men was positively correlated with mindfulness and social support, and negatively correlated with fertility stress (p &lt; 0.05); mindfulness could directly affect the core and treatment modules of fertility life quality, and indirectly affect the core of fertility life quality through social support (mediation effect accounted for 19.0%), while the treatment module (mediation effect accounted for 13.7%), and the core module indirectly affected fertility life quality through fertility stress (mediation effect accounted for 16.8%).

Conclusion

The fertility quality of life of infertile men is not optimistic. Mindfulness-related interventions and programs can improve their fertility quality of life.

Revealing Mental Health Information in Friendships: The Role of Disclosure Strategy and Perceived Recipient Response on Disclosure Outcomes

Processes of revealing, or disclosures, take various forms, and are sometimes referred to as disclosure strategies. How individuals share information influences how recipients respond, which may have important consequences that shape perceptions of the overall interaction and relationship satisfaction. This research explores mental health disclosures among friends to understand how (a) one's disclosure strategy predicts their perceptions of the recipient response, (b) perceived recipient response predicts perceptions of disclosure outcomes, and (c) perceived recipient response potentially mediates the relationships between disclosure strategies and disclosure outcomes (e.g., interaction success, relationship satisfaction). Participants were 144 individuals who had disclosed their mental health condition to a friend. Analyses revealed that when disclosing mental health information to a friend, strategy use was, in part, predictive of perceived recipient response which, in turn, predicted discloser's ratings of disclosure outcomes. This manuscript discusses implications of findings and suggests directions for future research.

The roles of mental illness disclosure and disclosure strategies on well-being among college students

ObjectivesTo examine how the degree of mental illness disclosure and disclosure strategies are associated with psychological and physical well-being among college students. Participants: Participants were 181 undergraduate students from two American universities who self-identified as having been diagnosed with mental illness. Method: Participants completed an online survey, which included measures of mental illness disclosure and a range of outcome measures (e.g., life satisfaction, self-report somatic complaints). Results: The degree of mental illness disclosure was positively related to well-being outcomes. After controlling for the effect of the degree of self-disclosure, a direct disclosure strategy was positively associated with well-being outcomes, whereas disclosure strategies involving entrapment, humor, and indirect medium were related to poorer well-being outcomes. Conclusions: Results suggest that the degree of mental illness disclosure and the manner in which individuals disclose their mental illness to others may have implications to the well-being of individuals living with mental illness.

Mediating Effects of Emotional Self-Disclosure on the Relationship between Depression and Quality of Life for Women Undergoing In-Vitro Fertilization

This study aimed to identify the moderating and mediating effect of emotional self-disclosure between depression and quality of life for women under infertility treatment. The subjects included 169 infertile women under in vitro fertilization (IVF) treatment. The data were collected by self-administered questionnaires from June to August in 2019. The questionnaire consisted of questions about depression, emotional self-disclosure, and fertility quality of life. Descriptive statistics, t-tests, one-way analysis of variance, correlation, and stepwise multiple regression were analyzed using the SPSS 25.0 Windows program. Depression had a negative correlation with emotional self-disclosure (r = -0.189, p = 0.014) and fertility quality of life (r = -0.532, p < 0.001). Emotional self-disclosure had a positive correlation with fertility quality of life (r = 0.259, p = 0.001). These results confirm that emotional self-disclosure has mediating effects between depression and fertility quality of life. Therefore, nursing interventions for IVF patients need to encourage expressing and sharing various emotions experienced through the diagnosis and treatment of infertility in order to alleviate negative emotions.

Experiences of Women with Male Factor Infertility under In Vitro Fertilization

Purpose: This study attempts to explore the experiences of infertility among women with male factor infertility. Methods: From April to July 2018, nine women with experience of male factor infertility and assistant reproductive technology were interviewed. The transcribed data were qualitatively analyzed to identify major themes and sub-themes representing participants' experiences with male factor infertility. Results: The analysis indicated that the women's infertility experiences were structured into five theme clusters: "Difficult to accept the situation", "Confused inside", "Destroyed relationships due to blaming and anger", "Desire social support", and "Embracing hurt feelings and regaining strength". Conclusions: Intervention programs are needed to closely investigate the psychological status of women with male factor infertility and help with their physical and psychological well-being. Efforts to address infertility through effective governmental support for infertility, a strategy for promoting the social recognition of infertility, and the health professional's persistent interest and collaboration, are discussed.

Factors Underlying Engagement in Facebook Support Groups of Female Infertility Patients

Women dealing with infertility issues may well undergo a long process of treatments and they are also likely to feel empty, defective, inadequate and worthless. Some of these women join online support groups in order to share their experiences, get information and ease their pain. One important positive phenomenon of the Internet is the advent of online support groups. These are designed to foster well-being and increased social interaction, and to offer 24/7 availability with no geographical restrictions. This study, comprising 191 female participants who answered an online survey, focused on closed Facebook support groups, the members of which were women undergoing treatments for infertility. The study examined to what extent the degree of engagement by these women in online support groups could be predicted by external factors (family status, social and family support, the importance of the group and the duration of membership) and internal factors (extroversion, openness to experience, subjective happiness and loneliness). Findings show that higher levels of engagement in such Facebook support groups are predicted by the external factors, including having a child, longer duration of membership in the group, family support and the strongest predictor, perception of the group as important. Findings also show that higher levels of engagement in these groups are predicted by internal factors extroversion and openness to experience, as was found in previous studies of other populations. Results and future research are discussed.

Donor insemination disclosure in social networks: heterosexual couples' experiences

The way in which heterosexual couples manage information about infertility and donor insemination within their social networks has not yet been explored in-depth. This study focuses on how parents and aspiring parents manage information about infertility and donor insemination within their social networks. Fifteen Belgian couples were interviewed as part of a parenthood research project. Thematic analysis resulted in the identification of four themes. The first of these reveals how the social context can best be understood as a continuous confrontation with social expectations. A second theme highlights the diverse ways in which couples manage personal information in this confronting context. The third theme stresses how couples manage information about donor insemination so as to be treated as a 'normal' family. The final theme shows how emotional regulation within the context of the extended family plays a role in couples' decisions about how to manage information with relatives. Results are analysed using the concept of 'systemic emotion management' and the importance of being seen by others as a 'normal' family. Study findings signal the importance of managing information within social networks and are of relevance to a range of practitioners.

Fertility quality of life tool: update on research and practice considerations

The 36-item Fertility Quality of Life (FertiQoL) tool is increasingly used in research and practice. It measures quality of life in four personal domains (emotional, social, relational, mind/body) and two treatment domains (tolerability, environment). A literature review of published empirical research using FertiQoL was undertaken to provide an overview of this research base. Five databases were searched using 'FertiQoL' and its variant. In total, 41 published articles from 35 independent samples in 23 countries involving 16,315 participants, mainly in clinical settings, were reviewed. FertiQoL was used for three main purposes: (i) to assess quality of life and FertiQoL measurement properties (especially Core FertiQoL) using cross-sectional designs; (ii) to identify correlates, predictors, and consequences of fertility quality of life (some of which included international comparisons); (iii) to assess the effect of psychological interventions on fertility quality of life. The range of median FertiQoL Core, Treatment and subscale (scaled) scores in 31 samples was between 60 and 75. Poorer fertility quality of life was consistently associated with being a woman, longer duration of infertility, poorer psychological functioning and lower patient-centred care. Some FertiQoL subscale scores improved after psychological interventions. Future research should address measurement issues and examine reported associations with fertility quality of life.

Lifestyle and fertility: the influence of stress and quality of life on female fertility

There is growing evidence that lifestyle choices account for the overall quality of health and life (QoL) reflecting many potential lifestyle risks widely associated with alterations of the reproductive function up to the infertility. This review aims to summarize in a critical fashion the current knowledge about the potential effects of stress and QoL on female reproductive function. A specific literature search up to August 2017 was performed in IBSS, SocINDEX, Institute for Scientific Information, PubMed, Web of Science and Google Scholar. Current review highlights a close relationship in women between stress, QoL and reproductive function, that this association is more likely reported in infertile rather than fertile women, and that a vicious circle makes them to have supported each other. However, a precise cause-effect relationship is still difficult to demonstrate due to conflicting results and the lack of objective measures/instruments of evaluation.

Disclosing Mental Illness Information to a Friend: Exploring How the Disclosure Decision-Making Model Informs Strategy Selection

Within the context of mental illness disclosure between friends, this study tested the disclosure decision-making model (DD-MM; Greene, 2009) to comprehensively investigate factors that predict disclosure enactment strategies. The DD-MM describes how individuals determine whether they will reveal or conceal non-visible health information. Processes of revealing, called disclosures, take various forms including preparation and rehearsal, directness, third-party disclosure, incremental disclosures, entrapment, and indirect mediums (Afifi & Steuber, 2009). We explore the disclosure decision-making process to understand how college students select to disclose their mental illness information with a friend. Participants were 144 students at a Midwestern university who had disclosed their mental illness information to a friend. Structural equation modeling analyses revealed that college students choose strategies based on their evaluation of information assessment and closeness, and that for some strategies, efficacy mediates the relationship between information assessment and strategy. This manuscript discusses implications of findings and suggests direction for future research.

Investigating the Relationships among Stressors, Stress Level, and Mental Symptoms for Infertile Patients: A Structural Equation Modeling Approach

Objective

Patients with infertility are a high risk group in depression and anxiety. However, an existing theoretically and empirically validated model of stressors, stress, and mental symptoms specific for infertile patients is still a void. This study aimed to determine the related factors and their relational structures that affect the level of depressive and anxiety symptoms among infertile patients.

Methods

A cross-sectional sample of 400 infertility outpatients seeking reproduction treatments in three teaching hospitals across Taiwan participated in the structured questionnaire survey in 2011. The hypothesized model comprising 10 latent variables was tested by Structural Equation Modeling using AMOS 17.

Results

Goodness-of-fit indexes, including χ²/DF = 1.871, PGFI = 0.746, PNFI = 0.764, and others, confirmed the modified model fit the data well. Marital stressor, importance of children, guilt-and-blame, and social stressor showed a direct effect on perceived stress. Instead of being a factor of stress, social support was directly and positively related to self-esteem. Perceived stress and self-esteem were the two major mediators for the relationships between stressors and mental symptoms. Increase in social support and self-esteem led to decrease in mental symptoms among the infertile patients.

Conclusions

The relational structures were identified and named as the Stressors Stress Symptoms Model, clinically applied to predict anxiety and depression from various stressors. Assessing sources and level of infertility-related stress and implementing culturally-sensitive counseling with an emphasis on positive personal value may assist in preventing the severity of depression and anxiety.